Reported Outcomes

Description:

Colorado is using an Accountable Care Collaborative (ACC) model to expand medical home services for their adult and pediatric Medicaid population. Under this model, primary care medical providers (PCMPs) will contract with regional care collaborative organizations (RCCOs) to provide medical home services to Medicaid enrollees.The goal of the ACC is to have every member linked with a primary care medical provider (PCMP) as his or her central point of care, and the PCMPs are directly responsible for ensuring timely access to primary care for ACC members. PCMPs function as medical homes, a model that promotes comprehensive,coordinated, team-based, and client-centered care and enhances client experience and outcomes.

PCMPs are also responsible for assessing members’ nonmedical needs and helping them to access wraparound services such as housing assistance, longterm services and supports, behavioral health care, child care, transportation, food assistance, and other community services. PCMPs may provide this support directly, or it may be provided by Regional Coordinated Care Organization (RCCO) care coordinators. The RCCO helps providers to communicate with Medicaid clients and with each other, so Medicaid clients receive coordinated care. An RCCO will also help Medicaid clients get the right care when they are returning home from the hospital or a nursing facility, by providing the support needed for a quick recovery. An RCCO helps with other care transitions too, such as moving from children's health services to adult health services, or moving from a hospital to nursing care.

Over the last 3 years, the Accountable Care Collaborative (ACC) has transformed Colorado Medicaid. In the ACC, Medicaid members receive coordinated care from a patient-centered medical home and PCMPs have support in order to provide high quality and efficient health care services.

Once an RCCO shows cost neutrality, $1 PMPM is withheld from both the PCMP and RCCO, creating a shared quarterly incentive payment pool. The $1 PMPM can be recouped by each entity by meeting specific performance goals. * Pediatric PCMPs cannot receive enhanced payments from both the Medical Homes for Children and the ACC programs. They are only eligible to receive the Medical Home for Children Program performance payments for their patients.

Primary Care Medical Providers will receive fee-for-service reimbursements for medical services rendered to enrolled Medicaid beneficiaries. In the program’s expansion phase, RCCOs and Primary Care Medical Providers are eligible to receive incentive payments: initial incentive payments will be available for RCCOs and Primary Care Medical Providers that reduce emergency room visits, hospital re-admissions, and utilization of medical imaging. PMPM payments to RCCOs and Primary Care Medical Providers will be reduced to $12 and $3 respectively, with $1 from each withheld to support incentive payments based on achievement of performance targets. The state hopes to incorporate a shared savings component at a later date as more beneficiaries enroll in the ACC program.

In 2015, RCCOs will receive a full permember-per-month payment only for members who are attributed to a medical home within six months of enrolling in the ACC.

Fewer ED / Hospital Visits:

ACC 2014 Annual Report (November 2014)

8% fewer ER services for adults enrolled in ACC for more than 6 months vs not enrolled

Fewer readmissions for children and adult ACC members without disabilities vs. non-enrolled

Use of ER services for ACC members with disabilities was slightly higher than for those not enrolled

3% fewer imaging services for ACC members with disabilities (vs. not enrolled)

16% fewer imaging services for adult ACC members (vs. not enrolled)

12% fewer imaging services for children ACC members (vs. not enrolled)

Colorado Legislative Report (November 2013) outcomes relative to a comparison population prior to program implementation:

15-20% reduction for hospital readmissions

25% reduction in high cost imaging services

Reduction in hospital admissions

9% among members with diabetes

5% among members with hypertension

22% among ACC members with COPD who have been enrolled in the program six months or more, compared to those not enrolled

Emergency room utilization by ACC enrollees increased 0.9 percentage points less than utilization by those not enrolled in the ACC program, or an increase of (1.9%) for ACC enrollees compared to an increase of (2.8%) for those not enrolled

Improved Health:

Colorado Legislative Report (November 2013)

Lower rates of exacerbated chronic health conditions such as hypertension (5%) and diabetes (9%) relative to clients not enrolled in the ACC Program

Cost Savings:

ACC 2014 Annual Report (November 2014)

The ACC program generated approximately $100 million in gross program savings ($31 million in net savings) in FY2013-2014

In FY2013-2014, approximately $14 million was reinvested into providers by the program (including incentive payments)

Colorado Legislative Report (November 2013)

$44 million gross, $6 million net reduction in total cost of care (cost avoidance) for clients enrolled in the ACC Program

Increased Preventive Services:

Colorado Legislative Report (November 2013)

Increased preventive services for individuals with diabetes

Other Outcomes:

ACC 2014 Annual Report (November 2014)

50% of all children under age 18 enrolled in the ACC had at least one well-child visit this year